| NPI | 1073814919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7952726-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31746) |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2011-06-08 |